What is the best therapeutic option for individuals with atrial fibrillation (AF or AFib) and chronic kidney disease (CKD)? Currently, doctors typically recommend direct oral anticoagulants (DOACs) to patients with atrial fibrillation to prevent strokes, as opposed to warfarin. However, this line of treatment could cause excessive drug exposure and increased bleeding in those who have CKD. According to the AJMC, researchers recently sought to understand the patterns of prescribing these medicines and treating these conditions.

In the data, which is published in Open Heart, the research team sourced data from 6,567 adult patients with atrial fibrillation and CKD within the AuriculA registry. The patients were treated over a 5-year period. Findings from the study show that:

• Patients whose CKD became progressively worse were often older, male, and had other conditions or comorbidities.
• The use of DOACs significantly increased over the study period, rising from 9.2% use to 89.3% use. Alternately, the use of warfarin for treatment significantly fell from 90.8% to 10.7%. 
• DOACs were used less frequently within patients who had severe or end-stage chronic kidney disease.
• While DOACs were most commonly used, researchers did find that patients often experienced a slight but progressive loss of renal function. 

Ultimately, the study highlighted how patients with atrial fibrillation and CKD are more commonly taking DOACs over other forms of therapy. The researchers also state that those at risk of developing severe or end-stage renal failure should have their doctors consider treatment adjustments to ensure the best safety and quality-of-life. 

About Atrial Fibrillation (AF) 

Atrial fibrillation (AF) refers to an abnormal and often rapid heart rate that could lead to blood clots in the heart. AF also increases the risk of developing heart failure, stroke, or other heart-related complications. It occurs when the two upper heart chambers experience chaotic electrical signals. These may be caused by coronary artery disease, congenital heart defects or abnormal heart valves, metabolic imbalances, stimulant exposure, an overactive thyroid gland, previous heart surgery, sick sinus syndrome, viral infections, stress, or sleep apnea (among others). AF may be considered occasional/paroxysmal, persistent, long-standing, or permanent. 

While this is not an exhaustive list of symptoms, nor is it a list of symptoms that every person with AF experiences, symptoms can include:

• Fatigue
• Shortness of breath
• Chest pain
• Heart palpitations
• Exercise intolerance
• Dizziness, confusion, and/or lightheadedness